Improving Patient Care, Provider Cost Efficiency Through EHR Automation

In an interview with Integrated Healthcare Executive, Cindy Gaines, chief clinical transformation officer at Lumeon, discusses the current state of electronic health records and the potential benefits of integrating automation into EHR data entry for health care providers and clinical staff. 

My name is Cindy Gaines and I am the chief clinical transformation officer for Lumeon. I have been a nurse for over 35 years, and I have spent most of that time working within health systems. I shifted and was the quality leadership, vice president for population health and my previous role was being president of a medical group.

I had the opportunity to come to work on the vendor side of health care about 4 years ago but in many ways my role is to help to translate between these two worlds. I'm excited to be part of Lumeon and the work we are doing with clinicians to automate care.

Could you share what the current state of electronic health records (EHRs) is and why there is a need for system improvements? 

EHRs were implemented by health care organizations over the last 15 to 20 years. While EHR systems are very necessary, they are a system of record primarily created for billing documentation. They were first created to document a regulatory environment and not to oversee patient care.

Because current EHR systems of record don't meet all health care system needs, many health systems are now adding supplementary software. Some of the other functions being added are tools for self-scheduling and managing forms and documents. However, the focus on EHR expansion through use of automation often is not producing a desired return on investment because there is friction between the new and existing software. 

How do you believe better integrating automation to EHR data entry can benefit health care providers and clinical staff? 

The key to that question is the data entry, isn't it? How much time we spend getting information into the EMR is a real challenge. We spend a ton of time transcribing what patients say into the EMR. We’re trying to make sure we have an accurate record and to do that, data automation must be thought about differently. How do we take advantage of a patient answering a question and then enter that into the EHR on behalf of the provider? 

One of the things we focus on with automation is having the patient answer a question and then loading that patient information into a worksheet within the EMR. This way, as a provider, you can go into the system and easily find the data, review, and edit. 

I was talking to an organization just yesterday who shared a problem they are having where when loading in documents everybody is labeling them differently. A potential solution is to directly load into a worksheet with automation and it could save staff from having to do that. We want clinicians to focus their time on treatment and action, not worrying about accurate transcription. 

How can these updates improve patient outcomes and overall care delivery? 

One thing we're good at in health care is defining and sharing best practices. Where we more often fail as health care workers is in the execution of best practices. Failing to adhere to best practices is often because clinicians are being interrupted throughout their workflow. It's unfortunate but true. If we all executed our best practices perfectly, every heart failure patient would have an appointment within 7 days of discharge. 

When need to think of automation in terms of helping with execution. Take that best practice workflow and look for opportunities to automate that can keep that workflow moving as it should and alert the team, and even the patient, when the course is being deviated from and needs to be redirected. Think about the best practice workflow like train rails that are helping to keep that best practice moving along and reaching the desired outcome. When the best practice workflow is on track, it is a win-win for patients and health care teams alike. 

Can you explain how implementing automation can address cost and revenue challenges faced by health systems today?

Probably the biggest cost challenge in health care right now is staffing. We are short on staff nationally and internationally. In the US, many health systems are supplementing staffing with an agency which is very expensive. This solution is temporary to keep health care services available to patients as we come out of the pandemic. 

When looking to reduce costs, sometimes it's about finding the efficiencies. I'll use an example of an organization we worked with that wanted a more efficient process of getting a patient ready for surgery. The care team said they either needed more staff or to find efficiencies because they had other patients in need of care. 
In working with this team, one of the first steps to take was having the patients complete the intake form themselves. The care team then uploaded the form into the EHR.

This change meant the staff saved time because they did not have to conduct an intake with patients by phone or in person. The new process saved the care team about 30 minutes per patient and 89% of the patients filled out the form by themselves. Multiply that saved time by 12,000 patients and suddenly, we've freed up over 5,300 hours of time to devote to other patients. Time saved can also then be equated to financial savings. When you take the average cost expense of a nurse per hour, and that pay is multiplied by hours of saved time, the savings stack up. 

Oftentimes, we fear that more automation means replacing people. I don't think of it that way. I think saved time and money are expanded resources. The outcome is not reducing the care teams, it is giving the teams time back to help patients who need the most help. We're at a time in health care where leaders need to think about how we do things differently and automation has a lot of potential.